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Incidence and characteristics of paediatric abusive head trauma in Taiwan, 2006–2015: a nationwide population-based study
  1. Yi-Ting Chang1,
  2. Hsin-Yi Chang1,
  3. Li-Wen Chen2,
  4. Tsung-Hsueh Lu3,
  5. Hui-Ju Tsai4,
  6. Yi-Wen Chen1,5,
  7. Yu-Chun Chang5,
  8. Jui-Ying Feng1,5
  1. 1Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  2. 2Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  3. 3Department of Public Health, National Cheng Kung University, Tainan, Taiwan
  4. 4Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
  5. 5Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  1. Correspondence to Jui-Ying Feng, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; juiying{at}


Objectives To examine the incidence rate and characteristics of paediatric abusive head trauma (PAHT) among children under age 5 years in Taiwan.

Methods The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was used to identify broad and narrow definitions of children aged under 5 years with PAHT from 2006 to 2015 in Taiwan using a representative national insurance research database. Medical resource utilisation was also analysed. Incidence rates per 100 000 person-years were calculated and presented with 95% CI. Joinpoint regression analysis was used to detect the changes in trends and calculate the annual percentage change in PAHT incidence over time.

Results From 2006 to 2015, 479 (narrow definition) and 538 (broad definition) PAHT cases were identified. Incidence rates of PAHT by narrow and broad definitions among children under 1 year of age (18.7/100 000 and 20.0/100 000) were nearly 10-fold or 20-fold higher than for children aged 1–2 (1.7/100 000 and 2.1/100 000) and 3–5 (0.9/100 000 and 1.2/100 000) years. The PAHT incidence significantly increased since 2012, with trends varying by age and gender. Our results suggest that over 40% of the children with PAHT experienced serious injury and nearly 13% were fatal cases. For 87% (n=57) of fatal cases, this was their first ever hospitalisation. The number of fatal cases among infants was fourfold higher than that of children aged 1–5 years.

Conclusions This study provides a robust national estimate of PAHT and identifies infants as the most vulnerable group for PAHT in Taiwan. Education to enhance healthcare profession’s sensitivity and competence for the early identification and diagnosis of PAHT is critical.

  • violence
  • child abuse
  • mortality
  • child
  • epidemiology

Statistics from


  • Funding Funded by the Taiwan Ministry of Science and Technology, grant number (PI: J-YF: MOST 106-2314-B-006-011-MY3; H-JT: MOST 107-2314-B-400-031-MY3).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval from the University Institutional Review Board was obtained prior to the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Data used in this study are from the Health and Welfare Data Science Center, Ministry of Health and Welfare of Taiwan and are not publicly available.

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